What if alternative medicine really worked?

Generally speaking, fans and purveyors of so called “alternative” medicine insist it works. Rationalists and scientists generally insist that it doesn’t, or - more circumspectly – that there is no real evidence that it works. But just suppose it were found that a particular unorthodox treatment did work. Would this really strengthen the case for the notion of an “alternative” approach to healing?

Rather than take a real example, let’s take a fictional one. I don’t want to get bogged down in claims and counter-claims over the facts of any particular “treatment”, and I certainly don’t want anyone suing me.

Lets us pretend that there is an alternative therapy called “chrysanthemum therapy” or “CT” and that, it is claimed, CT (having a bunch of chrysanthemums in a vase in your bedroom) helps to treat the dreaded lurgi. Let us further suppose that CT has been ridiculed for many years by the medical profession who have their own orthodox treatment for the dreaded lurgi called “Lurgidium”.

Now finding out whether a treatment like Lurgidium really works is not as straightforward as many people believe. You can’t just try something out and say “oh yes I feel better now” and let that clinch the matter. Very few, if any, treatments work for everyone who tries them and you have to exclude the placebo effect and the nocebo effect and sampling errors and statistical artefacts. You have to make sure that you test a large enough sample of patients and that you test them for long enough and consider all sorts of other things you might not think of at first. This is all explained in terms any intelligent person can easily understand in @bengolding’s excellent book “Bad Science”. Scientists and clinicians have been working out whether stuff really works for a long time and have got the testing of medical treatments down to a fine art. Even so it sometimes goes wrong. One study provides one result; another study provides exactly the opposite result. Scientist then have to try and figure out why one study might be flawed and may have to come up with an even bigger and better study to clinch the matter.

Even if a treatment is shown to be effective, it might turn out to have unacceptable side effects (think of Thalidomide and – more recently – Vioxx). Scientists have to do a lot of testing before they can safely allow a drug onto the market.

Let us now suppose that some scientists decide to investigate chrysanthemums and find that these flowers release a gas comprising molecules that are a close analogue of the Lurgidium molecule and that inhaling small quantities of this gas really does help to treat the dreaded lurgi.

First of all, does this development vindicate the proponents of CT? Well that depends. If the proponents of CT have been simply saying something of along the lines of “CT has been used for many centuries in folk medicine and there is a lot of anecdotal evidence that suggests it works and is safe”, then fine. One could argue that the proponents of CT have been vindicated.

If, however, the proponents of CT have been saying all along that “CT works because it aligns the energy channels in your auras with the rings of Saturn” then I think we have to conclude that the CT people have just managed to hit it lucky.

And what would happen following the discovery that CT really works? (Let us suppose that CT proves to be even more effective in dreaded lurgi patients than Lurgidium and turns out to be safer. ) The big pharmaceutical companies would immediately start to produce chrysanthemum extracts in the form of tablets and sprays and creams and sell them to lurgi patients and/or their doctors. Okay, there might be some resistance at first. The big pharmaceutical companies might have patents for Lurgidium and put a lot of money into Lurgidium’s development and testing. But, given a competitive market, if a better, cheaper alternatives came along they would be forced to start marketing products based on that alternative (at least until they could develop and patent something even better). It should be borne in mind that, as Ben Goldacre points out, many of the biggest purveyors of questionable “health supplements” are the big pharmaceutical companies, and many of CEOs of these firms would gladly sell their own grandmothers if they could make a few bob from it.

So where would that leave CT? Could it any longer be called “alternative”? It comes from a plant, but so do many orthodox medicines. It has a history of use going back a long way before modern medicine, but so does the use of opiates as analgesics.
The supposed dichotomy between “alternative” and “orthodox medicine” does not exist. The only real dichotomy is between treatments that have been shown (scientifically) to work and those that have not.

Perhaps some treatments that are currently considered to be alternative really do work and will be shown to work once they have been investigated thoroughly enough (though, surveying the “alternative” treatments on offer, it is hard to imagine that many of them will ever get over this hurdle and many of them, e.g. homoeopathy, have been conclusively refuted) . But if and when this happens, those treatments will immediately cease to be, in any meaningful sense, “alternative”.

In short, the very notion of “alternative” medicine is simply incoherent.